Schizophrenia is a complex brain illness in which sufferers experience some degree of loss of contact with reality. Common symptoms of schizophrenia include hallucinations, delusions, impaired thinking and memory and emotional disturbances. Schizophrenia is diagnosed in approximately 1% of the population.
What is Schizophrenia?
Contrary to popular belief, schizophrenia is not described as a split personality.
Schizophrenia is a mental illness characterised by two or more of the following symptoms, often called symptoms of psychosis:
- disorganised speech
- seriously disorganised or catatonic behaviour
- negative symptoms (see below).
Before schizophrenia can be diagnosed, these symptoms must impair social and occupational functioning and be continuously present for at least 6 months.
People with schizophrenia experience a number of positive and negative symptoms.
A delusion is a firmly held belief that causes significant distress to the person.
A hallucination is characterised by seeing, hearing, feeling, and/or smelling something that is not actually there. For example, a person who experiences auditory hallucinations may hear voices when no one is talking.
When a person has disorganised speech, their words or sentences are not connected properly.
A thought disorder is the inability to carry through a line of thinking in a way that makes sense to other people. This may result in speech that is disconnected, illogical and jumbled.
These may include:
- lack of motivation
- social withdrawal
- lack of insight
- reduced emotion or interest in things
- inappropriate responses
The person may not show all of the above symptoms.
A person may experience the following early changes before more obvious symptoms of psychosis develop:
Changes in mood: depression and lack of interest or drive; fear, anxiety and tension; irritability, quick temper or aggression.
Changes in behaviour: decreased appetite, social withdrawal, sleeping problems, unusual rituals, reduced attendance at school or work.
Changes in Thinking: concentration or memory problems, preoccupation with one or two things, ruminations on themes.
How common is schizophrenia?
The prevalence of psychotic disorders (the category of mental illness that includes schizophrenia) amongst adults in urban areas of Australia ranges from 4 to 7 cases per 1000 people.
It is estimated that schizophrenia and schizoaffective disorder comprise over 60% of these cases.
What causes schizophrenia?
There are a number of theories about what causes schizophrenia. Schizophrenia tends to run in families. A first-degree relative (parent, brother or sister, child) of someone with schizophrenia has approximately 10% chance of developing the disease, compared to 1% chance for someone in the general population.
Generally though, a range of factors have to be present for schizophrenia to develop.
Stressful events may increase the chance of symptoms developing in someone who is already vulnerable to developing schizophrenia. Many researchers believe that an excess of a certain neurotransmitter - a chemical that is responsible for communication between brain cells - plays a part in the development of schizophrenia. Increased levels of the neurotransmitter, dopamine, may be linked to some of the psychotic symptoms.
There is some evidence that recreational use of drugs such as cannabis, ecstasy and amphetamines can mimic the symptoms of psychosis. Use of these substances has also been associated with triggering episodes of the illness.
Treatment for Schizophrenia
Because schizophrenia can impact on many areas of a person’s thinking, behaviour and mood, treatment has to be multifaceted.
Early identification of symptoms is a priority since the person often lacks insight into their symptoms. Family members, friends and colleagues may need to initiate contact with a general practitioner or mental health service to organise an assessment.
Once the diagnosis has been confirmed, pharmacological AND non-pharmacological treatments are used.
Pharmacological treatments are necessary to treat the symptoms of schizophrenia. Antipsychotic medications are used to treat the positive and negative symptoms during the acute phase and also to prevent subsequent relapse. Other medications may be needed to treat mood or anxiety symptoms. Injectable antipsychotic medications may be useful if adherence to antipsychotic medication is a challenge for people who do not have insight into their symptoms,
Non-pharmacological treatments aim to maximise the level of functioning in the community, by returning the person to education or work, and to achieve stable remission. This may include psychoeducation, family interventions, vocational rehabilitation, cognitive-behaviour therapy, and other forms of therapy, especially for comorbid conditions, such as substance abuse, depression and anxiety. Assistance for accommodation, finances and employment may be required.
A multidisciplinary team approach with a consultant psychiatrist centrally involved is the ideal model of care in the acute phase of the illness. Shared care of the person with a general practitioner is important in the long term maintenance of good physical and mental health and prevention of relapse.